Wednesday, 3 December 2014

Women’s Autonomy and Demography: Women pay the price for population control

Prevelance of female sterilisation over male sterilisation

India is one of the first countries in the world to
have formulated family planning programmes.
Family planning programmes like mass sterilisation in India were introduced in
response to the booming population . However it is female sterilisation (tubectomy)
which has always been prevalent over male sterilisation (vasectomy) or other
contraceptive methods.

Recently, in one of the worst medical disasters in
India’s history, many women lost their lives in a mass sterilisation camp organised
in Chhattisgarh. Family members of the victims have reported how women were
pressurised to undergo sterilisation. Mahesh, brother-in-law of one casualty,
told the Indian Express newspaper, “They [health workers] said nothing would
happen, it was a minor operation. They herded them like cattle.”

However, this is not one of the rare cases where mass
sterilisation camp has killed women. Between 2003 and 2012, as estimated by various
reports, thousands of women died in sterilisation camps organised in various
states including Uttar Pradesh, Tamil Nadu, Maharashtra, Karnataka and Andhra
Pradesh.

Violating all medical guidelines, sterilisation camps
like the one in Chhattisgarh and others are often found to have used contaminated
medicines, rusted surgical equipments and unhygienic environment. Guidelines
which set the maximum limit of surgeries to 30 a day, have often been ignored
by doctors in sterilisation camps, were the operations outnumber the limit. The
cause of such tragedies can be related to sheer medical negligence, apathy of
doctors towards patients, poor state of health services in India and above all
violation of women’s rights over their bodies.

The District Level Household and
Facility Survey (DLHS) in 2007–08
revealed that over 35 per cent of married women in the the reproductive age group ( 15–49 years)
had undergone tubectomy, as against 1 per cent of men who have undergone
vasectomy. This is despite the fact that
Tubectomy as an irreversible method of birth control is a more complex procedure
than vasectomy.

In this light, it is important to
comprehend the relationship between family planning in India and female
sterilisation.

No choice for women: Social pressure, national targets

The
DLHS data in 2012-13 have also indicated State Governments preference on female
sterilisation over other contraceptive methods in India’s family planning
programmes. For example, in Andhra Pradesh, during 2007-2008 and 2002-2013, 60
and 63 per cent women in the fertile age range had been operated respectively.
However, during the same period, the number of men who underwent sterilisation,
came down from 4 to 2 per cent. A similar trend was observed across many states
in India.

This
trend can be traced to the deep rooted social belief that the primary role of women
is that of reproduction and child
rearing. Instead of looking at family planning as a responsibility of both men
and women, family planning programmes in India have been directed at women by
and large. Added to this there is a
tremendous social stigma attached to male sterilisation. Along with the fear of
impotency, physical weakness, “it becomes a question of manhood”, says Rukmini,
a District Reproductive and Child Health (RCH) Officer from Karnataka.
“Unfortunately social stigma nearly always ensures the fairer sex is the
subjugated lot…………….where women are more likely to go under the knife rather
than men.”

(The
Hindu)

In
a patriarchal society, women usually have little autonomy within and outside
the household; they also have limited control and no voice over their own
reproductive and contraceptive choices. Hence they are always made easy targets
of family planning programmes. For most women, sterilisation is not a choice,
it is a diktat. Thus women are forced to undergo sterilisation, sometimes
without their knowledge or opportunity to provide consent. According to the
DHLS 2007-08, 40 per cent of women who got operated across India were
illiterate. When women are poor and uneducated, they are more vulnerable, and are
easily persuaded to accept the painful and irreversible contraceptive method
through financial or other incentives. They are forced to undergo sterilisation
either by authorities responsible for family planning programmes or by family
members who are in need of monetary benefits. Women are convinced to undergo
surgeries by luring them with cash incentives. “The husband of a Baiga tribe
woman who died after undergoing tubectomy at a government-organised
sterilisation camp in Bilaspur district alleged that health workers put
pressure on them and also held out a promise of money for consenting to the
operation.” (India Today) This is nothing but grave violation of women’s
rights.

In
2012-13, the District Level Household and
Facility Survey highlighted poor quality family planning services which
were offered to women. Women were not informed about the side-effects of
sterilisation or about other methods of contraception. Even where women were counseled,
the staff strategically refrained from giving adequate and correct information.
For example, in Maharashtra, only 17 per cent of the women were told about the
side-effects, while in Punjab and Haryana only 14 per cent and 11 per cent women
respectively were given any information related to other methods of contraception.
Hence majority of these women could not have provided "informed
consent" due to lack of awareness and knowledge.

“The government of India denies that
there are targets but they’re clearly set and when it goes down to the district
or village level that’s a real problem. Extreme pressure is the crux of the problem,”
says Sona Sharma, joint director for advocacy at the New Delhi-based Population
Foundation of India. Senior
officials sometimes threaten health workers of reducing remuneration or suspending
them from work. “Health workers who miss sterilisation targets because they
give proper counseling and accurate information about contraception risk losing
their jobs in many parts of the country,” said Aruna Kashyap, women’s rights
researcher at Human Rights Watch.

To
achieve the desired target, in some districts, more than the prescribed numbers
of tubectomies are performed single handedly by a medical practitioner in
unhygienic and inappropriate conditions. As a perk, compensation is given to service
providers as well as acceptors of sterilisation. Unofficially
material benefits are also given to health workers and agencies organising
sterilisation camps. In 2011, service
providers in Rajasthan were reported to have been offered motorcycles,
television sets, even Tata Nano cars.

Reproduction and contraception is
for women: the social perception

In a study carried out in central
India about the men’s perception of contraception, it was found out “Men viewed
"family planning" as synonymous with female sterilization, whereas
they saw "contraception" as referring to spacing methods, knowledge
of which was limited. Thirty-four percent of men reported that their wives had
been sterilized; 79% of men who did not rely on any permanent method said they
wanted their wives to be sterilized. In focus group discussions, most men
reported themselves as their family's sole decision maker about reproductive
health.” (Male Perceptions on Female Sterilization: A Community-Based Study in
Rural Central India by Arundhati Char, Minna Saavala and Teija Kulmala).

Female sterilisation being dominant, use of other
spacing methods like Intrauterine Device (IUDs), condoms are limited,
despite the fact that there is a high unmet need in spacing. According
to DLHS III, all the spacing methods together account for just 25.5 per cent of
the current contraceptive use, compared to female & male sterilisations which
account to 75.5 per cent. Social and cultural acceptability of female
contraceptives over male contraceptives have also set a high competitive bar on
pharmaceutical industry and research that is prepared to invest more on the
former than the latter. According to RH Reality Check (a daily publication
providing news, commentary and analysis on sexual and reproductive health and
justice issues) “research on male contraception is 50 years behind research on
female contraception.”

Need to re-look at nation level population programmes
from women’s perspective

It
is a common perception shared by society that reproduction, and therefore
contraception, is the responsibility of a woman. Despite all talks of
empowering women and their reproductive autonomy, the right to choose whether
to have children or not and the freedom to choose the methods of fertility
management, based on access to proper information, has been largely denied to
them. This gets translated in the family planning programmes and practices as
well. It is sad that it is only by the death of several women in a botched up
attempt at sterilisation that the whole issue has been bought to the fore.

It
is time for the nation to understand that fundamental to the success of any
family planning programme is the enhancement of women’s freedom and it should
involve both men and women in its population stabilisation goal. More men
should be involved in family planning programmes “not as targets for vasectomy
but as partners within a gender-equality paradigm,” says Dr Abhijeet Das,
Director of CHSJ and an assistant professor at the Department of Global Health,
University of Washington.

The
need of the hour is to look at India’s population programmes from the
perspective of the women who are forced to suffer its consequences. In
addition, there is an urgent need to improve public health services in India,
make doctors and health agencies more accountable and eliminate coercive family
planning porgrammes, to ensure that women in Chhattisgarh or any other place do
not become victims of faulty sterilisation drive!